GP fatigue a 'risk' to patient safety, warns RCGP

2:38 July 31, 2015

The RCGP says that unlike professionals working in other ‘safety critical’ sectors, such as aviation or the oil and gas industries, GPs cannot sound a ‘distress signal’ when they are feeling overwhelmed or struggling with fatigue – and this could have a negative and potentially disastrous impact on their ability to deliver safe patient care.

The College claims that unrelenting and increasing workload pressures are pushing dedicated GPs to their limits as they try to cope with rocketing patient numbers with diminishing resources.

It is concerned that hard pressed GPs are working longer and longer days seeing patients, followed by many hours after surgery and at weekends trying to keep up to date with urgent paperwork, such as hospital referrals.

Whilst safety risks in general practice are inherently lower than those in hospitals, the College warns that there is considerable potential for patient harm – such as medication errors and mistaken patient identity – if GPs become persistently over-tired.

Regular, mandatory breaks for staff to minimise the possibility of errors

A mechanism to identify practices under extreme workload pressures – and for measures to be urgently implemented to relieve these pressures

A full-scale review of how daily pressures in general practice can be reduced – including ways in which existing bureaucracy and unnecessary workload can be safely cut.

The number of people attending general practice is growing – between 2008/9 and 2013/14, the number of GP consultations rose by 19% in England alone. Yet the total number of GPs across the UK grew by just 4.1% between 2008 and 2013 (headcount); this directly affects the number of patients a GP is responsible for across the whole country – with every GP having responsibility for a further 61 patients compared to 2009.

GPs and their teams are now seeing around 370m patients per year in England and general practice is managing 150,000 extra patients a day compared to 2008, which is close to the entire population of Oxford seeing their GP every single day.

Patients are also routinely living with multiple and chronic conditions, which are far more complex to deal with, especially within the constraints of a standard 10-minute GP-patient consultation. In England, the number of patients with more than one long term condition was predicted to rise from 1.9 million in 2008 to 2.9 million in 2018.

At the same time, the share of the NHS budget that general practice receives has fallen consistently, year-on-year, to just over 8% in England – a record low.

The College claims that GP stress and fatigue is exacerbated by the growing burden of red tape and bureaucratic burdens, caused by form filling, box ticking and preparing for practice inspection visits by regulators the Care Quality Commission.

Recent College research estimated that an additional 120 hours per GP per year could be spent on frontline patient care by reducing unnecessary bureaucracy

In its ‘blueprint’ for the future of general practice published immediately after the General Election, the College called for a nationally-funded occupational health service to be established for general practice.

Its first-ever UK-wide campaign, Put patients first: Back general practice, calls for the share of the NHS budget for general practice to be increased to 11% – and for 10,000 more GPs across the UK over the next five years.

The consultation paper launched today will be sent to the Department of Health, NHS England, Care Quality Commission, General Medical Council and patient groups for their views in a bid to open up a debate about GP fatigue and burnout – and come up with solutions for tackling the problem.

RCGP Chair Dr Maureen Baker said: “GPs will always work in the best interests of their patients – even when they are putting their own health at risk – but ironically this can actually have an adverse effect on patient safety.

“Few of us would voluntarily board a plane flown by a visibly tired pilot or get on a train where we knew the driver had spent too much time at the controls – yet there are no methods or systems for addressing doctor and staff fatigue in general practice.

“Even in other areas of the NHS, ‘distress signals’ – such as red and black alerts in hospitals – exist so that other clinicians can simply declare that they cannot take on further work safely.

“But unless we disrupt patient services – which is the last thing that GPs want to do – we currently have no strategies in place to prevent and reduce the risk of patient harm that might arise from having tired overworked doctors and practice staff.

“With waiting times to see a GP now a matter of national concern, and patients in some areas of the country facing waits of up to a month to see their family doctor or practice nurse, our members are routinely working 11 and 12 hour days in surgery to try and accommodate.

“You might be able to do this for a short time, but when it becomes the norm, mistakes are going to be made.

“Fatigue among GPs is building up, to the detriment of their own health, and over time this could have a devastating impact on the care that our patients receive.”

She added: “Our intention is not to panic patients but to send out a pre-emptive strike to ensure that we take steps now to protect patients from the risks arising from doctor and staff fatigue.

“Our workload is increasing but our workforce is reducing as thousands of family doctors approach retirement and insufficient numbers enter GP training to replace them, with the result that more family doctors are having to work unsafe hours to get the job done.

“The current GP workforce in England is approximately 3,300 too small, with this shortfall projected to grow to 8,000 by 2020 due to current changes in demographics and in the needs of our patients.

“GP fatigue is a clear and present danger to patient safety – and we urgently need to find workable solutions that will keep our patients safe now and in the future.

“The long-term solution is greater investment in general practice and more GPs. We must do everything we can to ‘recruit retain and return’ thousands more GPs to prevent hardworking and dedicated GPs being lost to patient care through ill health.”

Further Information

Notes to editor

The Royal College of General Practitioners is a network of more than 50,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

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